I am interested in keeping up on some academic topics I explored in residency, and furthering my various role(s) in my department. That means I’ve got to stay on top of an array of specialized news sources – from journals in several specialties, press releases, and web sites. A few years ago, this would’ve meant maintaining a hodgepodge of print and electronic resources, forcing me to thumb through a lot of journals’ tables of contents each month, or navigate dozens of bookmarks in my browser.

According to the Dartmouth Atlas of Health Care, care for people with chronic disease now accounts for more than 75% of ALL health care spending. One third of Medicare spending each year is spent on patients with chronic diseases who are in the last two years of their lives. And most of these patients have CHF, chronic lung disease, or cancer. Moreover, if Medicare spending is not reined in, it is expected to double over the next decade, reaching $4 trillion by 2017. 

Serum lactate levels are a useful tool in managing critically ill septic patients, but the levels are often not routinely drawn or rapidly available in some institutions. As sepsis or SIRS-related disease is time-crucial with the administration of antibiotics and early goal directed therapy important to overall mortality, this delay could potentially translate into a patient care issue for the Emergency Physician.

In 20 years it’s estimated that one in four emergency department patients will be over the age of 65. This shift will fundamentally alter the way you practice. Are you prepared?
A special report   
This case, originally published in January of 2009, sparked a lively debate online. Here are some highlights. Continue reading for the final analysis. 

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